yemenjmedYemen Journal of MedicinecoVolume 4 Issue 1MultidisciplinaryEnglishJanuary- April 2025NNY20250523ArticleBleomycin Pulmonary Toxicity in Patients with Germ Cell Tumors Treated with Bleomycin Containing Regimens: Experience with 4 CasesEnglishY170173Mohammed SadiqAhmed1EnglishNMohammad Abdel DaemYassin2EnglishYRawan AhmedMohammed3EnglishYAveen Sadiq4EnglishYAbdurahman MustafaKday5EnglishY10.63475/yjm.v4i1.0004Background: Information on Bleomycin pulmonary toxicity (BPT) in Qatar is scarce. The aim of this study was to estimate the prevalence of BPT and to describe its clinical significance and outcome in germ cell tumor (GCT) patients who received bleomycin-containing regimens. Methods: This retrospective cross-sectional study was conducted at the National Center for Cancer Care and Research. It included all patients diagnosed with GCT and treated with a bleomycin-containing regimen between January 2002 and December 2008  Results: We identified fourteen patients with GCT who received bleomycin containing regimen. Four of them (28.5%) had developed BPT, and they were males with mean age of 39.3±8.3 years (range: 25-46 years). The calculated creatinine clearance before treatment was normal in the 4 cases. Evaluation of the chest computed tomography scan before starting bleomycin containing regimens revealed that none of our patients had pre-existing parenchymal lung disease. The mean cumulative bleomycin dose was 187.5± 153.7 U, while the mean time to onset of BPT was 3.5±2.1 months. Once the diagnosis of BPT was established, bleomycin was discontinued in the four patients and short courses of dexamethasone were administered. Two patients (50%) died, while one patient survived with a fibrosis sequel, and the fourth patient recovered without a fibrosis sequel.  Conclusion: BPT is one of the life-threatening side effects of this drug that every doctor should be aware of when treating GCT, therefore, a high index of suspicious is needed for early recognition of BPTs.  EnglishBleomycin, pulmonary toxicity, Germ cell tumor, corticosteroidshttps://www.yemenjmed.com/admin/abstract?id=158References1619Oand;#39;Sullivan JM, Huddart RA, Norman AR, Nicholls J, Dearnaley DP, Horwich A. Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours.and;nbsp;Ann Oncol. 2003;14:91-96.Kwan EM, Beck S, Amir E, Jewett MA, Sturgeon JF, Anson-Cartwright L,and;nbsp;et al. Impact of granulocyte-colony stimulating factor on bleomycin-induced pneumonitis in chemotherapy-treated germ cell tumors. Clin Genitourin Cancer 2017. pii: S1558-7673 (17) 30267-7.Maruyama Y, Sadahira T, Mitsui Y, Araki M, Wada K, Tanimoto R,and;nbsp;et al. Prognostic impact of bleomycin pulmonary toxicity on the outcomes of patients with germ cell tumors. Med Oncol 2018;35(6):80Ge V, Banakh I, Tiruvoipati R, Haji K. Bleomycin-induced pulmonary toxicity and treatment with infliximab: A case report.and;nbsp;Clin Case Rep. 2018;6: 2011-2014.Sleijfer S.and;nbsp;Bleomycin‐induced pneumonitis.and;nbsp;Chest. 2001;120:617‐624.Fyfe AJ, McKay P. Toxicities associated with bleomycin. J R Coll Physicians Edinb 2010; 40:213and;ndash;5Zhao Q, Cao D, Yu M, Yang J, Liu Y, Xiang Y, et al. Safety and efficacy of bleomycin/pingyangmycin-containing chemotherapy regimens for malignant germ cell tumor patients in the female genital system.and;nbsp;Oncotarget. 2017;8(9):15952-15960.Liu T, De Los Santos FG, Phan SH. The Bleomycin model of pulmonary fibrosis. Methods Mol Biol. 2017;1627:27‐42.Iacovino JR, Leitner J, Abbas AK, Lokich JJ, Snider GL. Fatal pulmonary reaction from low doses of bleomycin. An idiosyncratic tissue response. JAMA 1976;235:1253-5Reinert T, Baldotto CSdR, Nunes FAP, Scheliga AAdS. Bleomycin-induced lung injury. J Cancer Res 2013; 2013:9Barnardt Pand, Griffith-Richards S. Ovarian germ cell tumour and bleomycin-induced lung injury. Southern African Journal of Gynaecological Oncology 2018; 10:30and;ndash;33.and;nbsp;Roncolato FT, Chatfield M, Houghton B, Toner G, Stockler M, Thomson D, et al. The effect of pulmonary function testing on bleomycin dosing in germ cell tumours. Intern Med J 2016;46:893-8.and;nbsp;McKeage MJ, Evans BD, Atkinson C, Perez D, Forgeson GV, Dady PJ. Carbon monoxide diffusing capacity is a poor predictor of clinically significant bleomycin lung. New Zealand Clinical Oncology Group. J Clin Oncol 1990;8:779-83.Watson RA, De La Peand;ntilde;a H, Tsakok MT, Joseph J, Stoneham S, Shamash J, et al. Development of a best-practice clinical guideline for the use of bleomycin in the treatment of germ cell tumours in the UK.and;nbsp;Br J Cancer. 2018;119:1044-1051.White DA, Stover DE. Severe bleomycin-induced pneumonitis. Clinical features and response to corticosteroids. Chest 1984;86:723-8.